Federal officials are proposing to ease 40-year-old restrictions on the release of information about patients’ drug- and alcohol-abuse treatment, so their electronic medical records can be more easily used and shared.

Federal law has long protected substance-abuse-treatment records from being disclosed to anyone without a patient’s explicit consent, so that fear of stigma or discrimination wouldn’t deter those in need from seeking help. If a patient agrees to share substance-abuse records with, say, a doctor or hospital, those records can’t be sent anywhere else unless the patient consents again.

Officials at the Substance Abuse and Mental Health Services Administration, known as SAMHSA, say those rules didn’t envision today’s highly integrated health-care systems that rely on the broad sharing of patients’ detailed electronic medical records to coordinate care. The Obama administration is paying doctors and hospitals $36 billion in incentives to move to such systems, which proponents say can reduce medical errors and duplication and cut costs.

But privacy advocates are concerned that one of the nation’s toughest confidentiality rules could be weakened, and they worry that the wider information is shared in the health-care system, the greater the risk of public disclosure. “If we lose this, people will stop getting treatment,” says psychiatrist Deborah Peel, founder of the nonprofit Patient Privacy Rights Foundation.

Despite anti-discrimination laws, many people in treatment still fear that exposure of their drug or alcohol problems could jeopardize their careers or their ability to get life insurance or retain child custody, addiction and legal experts say.